This article discusses everything you need to know about epidural hematoma: its definition, causes, diagnosis and management.
What is an epidural hematoma?
Epidural hematoma is a accumulation of blood causing a blood effusion to form between a bone in the skull and the dura mater of the brain. It is due to major head trauma in humans, and these traumas even have frequent causes of mortality in young adults. It is therefore necessary to quickly carry out a clinical and radiological examination in order to be able to take charge of the person.
This is often a surgical emergency. If there is no immediate intervention, the only possible evolution of this trauma remains the death of the patient, because the brain will end up being suffocated by this accumulated blood which is released from the ruptured middle meningeal artery. It is important to emphasize that the hematoma forms in a few hours.
Classically it occurs mainly in young people. Its origin after a head trauma is linked to an arterial lesion following a fracture of the vault.
There is also another type of hematoma calledsubdural hematoma. This is an accumulation of blood in the epidural space which leads to compression of the spinal cord. Its diagnosis is made by MRI or on myelo-CT, and it is treated by surgical drainage.
Epidural hematoma can also result from spinal trauma during anticoagulant or thrombolytic therapy, or from lumbar puncture in case of blood crasis disorders. It is usually thoracic or lumbar, and is often caused by trauma.
First you have to understand skull anatomy : There are eight cranial bones which fuse together and form the skull which is shaped like a hollow balloon that surrounds the brain.
But that's not all; There is also what is called the meninges. If the brain rested directly on the skull, it would be hit every time you hit your head, but fortunately it is protected by the meninges. It is a thick membrane that lines the inside called the dura mater.
In order for epidural hematomas to form, there must be a blow to the head which must be quite significant. But for bleeding to occur outside the dura mater, there may be certain predisposing factors.
For example, people who take blood thinners or who have bleeding disorders are more exposed to this kind of problem. Older people and people who drink a lot of alcohol are also at higher risk.
After the person hits his head hard, a blood vessel in the dura mater will rupture, and blood will quickly settle between the skull and the dura mater. The skull being hard and resistant, it will not move. The dura mater, although also resistant, will migrate towards the center of the skull and thus compress the brain.
Symptoms of the disease
All lesions that affect the skull have the same symptoms and manifest themselves in the same way.
The person with this trauma will show the following signs:
- fluctuating drowsiness,
- Memory impairment
- Paralysis on the opposite side of the body
- Loss of consciousness
- Nausea and vomiting
So it is not possible to distinguish or to say that it is about such or such cranial traumatic type.
But there are still specific symptoms of the disease that signal that it is indeed a trauma. Among the most important are:
- Unequal pupils.
- Very high blood pressure
- Slow and very strong pulse
- The inability to wake up.
The person with an epidural hematoma should be taken care of and given first aid immediately. These consist of taking care of any injury, being attentive if the person loses consciousness or not. If she loses consciousness, she must be quickly transported to hospital by ambulance.
Clinically speaking, we will do an examination where the head trauma took place, if it is really an epidural hematoma, we will find a wound, a bruise, a hematoma that is often painful on palpation. Epistaxis (bleeding from the nose) may also be observed.
Clinical examination will examine the sensitivity and motor skills of the patient after the trauma, as well as the reflexes. We also perform auscultation of the carotid arteries and pupil reflexes.
Twenty-four hours after the trauma, he may have an altered state. Indeed, the patient can lose consciousness and go into a coma, where we will observe in particular a motor deficit and mydriasis.
In addition to the clinical examination, it should be noted that the diagnosis of this disease is mainly based on theMRI. Le scanner is also a diagnostic test of choice for acute intracranial hematomas. It highlights a spontaneous hyperdensity indicating the existence of blood, the location of the epidural hematoma, as well as the existence or not of a fracture.
The differential diagnosis
Epidural hematoma can be confused with:
- Subdural hematoma
- Intracranial hemorrhage
- subarachnoid hemorrhage : Subarachnoid hemorrhage differs from extradural hematoma essentially by the absence of head trauma and, by the clinic which is characterized rather by a sudden headache accompanied by a meningeal syndrome.
- Carotid thrombosis
- Hypovolemic shock by associated lesions
- metabolic coma
For small hematomas, most often, no treatment is necessary.
To treat epidural hematoma, immediate surgical drainage is done right after transporting the patient to the hospital. The doctor does not opt for surgery, except for extreme cases where surgery is crucial.
The behaviour to have
Surgery is needed to treat epidural hematomas to remove blood from the space between the skull and dura by draining it, and release pressure from the brain.
How come ?
Surgeons will remove part of the skull and drain the hematoma, then leave the drain for a day to let the extra blood flow out.
It is also necessary to administer medication to the patient: 2.5 to 10 mg of phytonadione (also called vitamin K1) subcutaneously should be administered to patients taking coumarin anticoagulants. Patients with thrombocytopenia receive platelets.
Prevention of seizures
It should be kept in mind that there is 40% overall mortality, 30% if head trauma patients are operated on within four hours after the trauma, and 90% if the intervention occurs after this time.
If the patient survives after an epidural hematoma, it could unfortunately keep irreversible sequelae. For example, the affected person may become either totally or partially paralyzed, or even lose their sight.
The clinical symptomatology of post-traumatic intracranial hematoma is not unequivocal and combines various clinical signs.
The lesion diagnosis is computed tomography: the scanner provides the elements for the therapeutic, medical and surgical management.
The prognosis of serious lesions is correlated to the delay in this treatment. It is therefore essential to take anyone who has received a significant blow to the head immediately, as the first 24 hours may be without symptoms and this is the most decisive period for a better prognosis.
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